Residents sent to Physicians Health Programs (PHP) or Sham Psych Evals to push them out of residency

[MDPhDRecruiter]

I wanted to get the community opinion on this news story in my city. Apparently, local hospitals are using the Physicians Health Program to push out doctors with disabilities or who may make a patient safety claim. Physicians with no addiction issues were being forced into 60-90 days of in-patient rehab programs to keep their license. I know these programs are intended to help healthcare workers with addiction issues but this report is concerning. New Story on residents sent to PHPs below:
Doctors fear controversial program made to help them

Is this going on at your hospital and a common thing nationwide?

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[doctorKAT]

this happened to me. I end up quitting residency.

 

[BoardingDoc]

Apparently, local hospitals are using the Physicians Health Program to push out doctors with disabilities or who may make a patient safety claim.

Where are you getting this? There is literally nothing in the article that you linked which makes this claim. There seems to be a report about 1 guy who was tired all the time and his supervisors thought it was because of a drug/EtOH problem. Apparently it wasn't. One story is about someone with a hx of EtOH abuse who killed himself. One story talks about how docs don't want to use this program because of the stigma attached.

There is the line: "You start thinking after a while if there's some diagnosing for dollars going on because now it's not just substance use disorders, but now the “disruptive physician” and they're talking about aging physicians,” said Miday"

However, the person quoted is the mother of the doc who killed himself who admittedly had an alcohol abuse problem.

I'm not saying that what you're suggesting doesn't happen. I just don't see where that's coming from in relation to this article.

 

[JD-MD]

I wanted to get the community opinion:
Doctors fear controversial program made to help them

Is this going on at your hospital and a common thing nationwide?

JD/MD reporting in: There are several running legal cases on this issue. I would recommend anyone seeking legal help to got to the website Physicians Health Program Lawsuit

In Michigan there is an active class action: Federal Judge Allows Class Action to Proceed Against Michigan’s Professional Health Program in Groundbreaking Decision I posted the link to a blog discussing since I don't want to name the physicians involved if they aren't seeking publicity.

One Physician, Kernan Manion, setup a non-profit, the Center For Physicians Rights to help targeted physicians. CPR Main this is based on his lawsuit FindLaw's United States Fourth Circuit case and opinions.

The bottom line is that these programs are in theory to treat drug and alcohol addiction. They can charge doctors $500 to $1,000 a day for treatment. There are many stories of doctors who made a patient safety report or had a disability and were forced to go cross country to a rehab program for a week of evaluations that could cost $5,000 to $10,000 dollars. Then they are told that while they have no addiction or health issue, the program wants them to stay for 4-8 weeks at very high costs. If the doctor refuses this "treatment" or goes to just quite their job, then the program many times threatens to pull their medical license unless they stay and pay...After you complete the program you have to pay $500 a month for five years for "monitoring." Welcome to being a physician in America in 2019.

Imagine being an accountant during tax season, then told by a boss that since you are tired at work you need to get on a plane tomorrow for weeks of psych evals or you will be prevented from ever working again. If you quit your job you still will be prevented from working. This story is just the latest to break.

 

[Gastrapathy]

The flip side:
https://www.google.com/amp/s/www.sa...egedly-fell-down-during-surgery/?amp&page=all

 

[BoardingDoc]

As an aside, what's up with OP and JDMD having lurker accounts but both deciding after months or years that this will be their first post on SDN?

 

[Crayola227]

yeah, I don't know

I have seen discussions in other forums which are linked to other physicians by name, specialty, location, and face, so at minimum those docs who were discussing it were willing to be personally associated with their statements, in which case criticism of some of the programs and medical boards would not be entirely without the possibility of consequence, so that makes me more inclined to think that speaking up, at minimum they seem to be believing what they are saying, even if it's just one side. In my view, one side of a story is enough to make it worth looking into, if only to seek the other side. It implies there is another side.

This is not a fake issue, although I won't claim to know how common/uncommon it is

I personally know some physicians who have had less than what seems like fair treatment from employers and the medical board surrounding medical issues in physicians that does NOT include substance use. Fwiw.

 

[Crayola227]

As far as what effect PHP, board licensing issues, training, etc, has to do with physician mental health and suicide:

It's often said that, claims that training or oversight is a pressure that contributes to physician mental illness, suicide, substance abuse, reluctance to seek help, or whether or not it doesn't really have much to do with issues underlying it, or whether or not anything can be done, is all fraught with peril, and people posit that those issues exist independent of training/oversight, and that nothing can be done for it. Which is fine to be sceptical about such claims. However, I will say the following is a FACT

Many physicians do indeed cite the scrutiny as a major factor in their feelings of non-well-being, reluctance to seek help, and even suicidality. I've personally known physicians that said these things. I'm not saying so then we do nothing to monitor these physicians or to keep the public safe and themselves safe with various measures related to overseeing their practice, but that I think it's something to be sensitive to as we consider what is going on and what to do.

There are physicians out there that feel that PHPs can be overly aggressive and in some cases do more to further problems with physician and patient safety. Just something to consider.

 

[Mass Effect]

Come on, guys. How can anyone deny the harm that some of these PHPs do? I used to believe they had a physician's best interest in mind. I really did. I thought what a great resource for physicians. But after seeing what they recommended for a colleague, I absolutely feel there's more than meets the eye with these programs. The fact that they would even give the appearance of impropriety by aligning with such sketchy money-grubbing programs is reason enough to question their motives, never mind some of their baseless recommendations. The stories you read (and feel free to look them up all over the Internet) are horrendous - they latch onto someone's weakness and push them into a corner by threatening their job/license. If that person is a resident, that means threatening their career. I realize there's two sides to every story and in most cases, the doc isn't necessarily providing the whole story when sharing his/her experience, but even if half of what they say is untrue, it's still horrendous.

The "disruptive physician" is the new trendy target for these programs. If someone's disruptive, maybe think about why and aim to help them with that rather than bankrupting them with unnecessary programs that will do nothing but burden the physician with astronomical bills and forever be a red mark on their licensing apps.

 

[NotAProgDirector]

Some physicians run into health issues that impact their ability to practice safely -- could be mental health, physical health, substance use, or any combination. We need a way for those physicians to get help without ending their career. We also need to protect the public - impaired physicians need to have limits placed on their ability to practice.

In many ways, PHP's are a great solution. In my state, participating in the PHP keeps any adverse actions off your license, and they seem to be reasonable. But clearly, in some states it has not gone well -- no check-and-balance, no way to challenge, etc.

Seems like the following would be reasonable:
1. There should be a "firewall" between the people making the assessment, and the people delivering the treatment. The person who decides what interventions are needed can't have a financial interest in the outcome.
2. Local treatment options should be required, unless the treatment is truly specialized. In rural environments this might be more complicated or impossible.
3. There needs to be an appeal process. If the physician disagrees with the assessment, then there should be an option of getting a second opinion. However, if a physician gets a second opinion, is cleared, and then runs into trouble -- then I think that should end up on their license record.
4. Prhaps some limitations as to what types of problems can be referred in the first place (although this would be hard to operationalize.

 

[NotAProgDirector]

The article mentions that the resident who was having problems was asked a ridic question "are you using drugs?". That's not a ridic question, it needs to be asked.

The article is short on details, but it sounds like the Anesthesia resident discussed was clearly having problems. the article mentions that they asked for accommodations -- but it can be that the accommodations asked for are impossible to provide.

 

[Mass Effect]

Some physicians run into health issues that impact their ability to practice safely -- could be mental health, physical health, substance use, or any combination. We need a way for those physicians to get help without ending their career. We also need to protect the public - impaired physicians need to have limits placed on their ability to practice.

In many ways, PHP's are a great solution. In my state, participating in the PHP keeps any adverse actions off your license, and they seem to be reasonable. But clearly, in some states it has not gone well -- no check-and-balance, no way to challenge, etc.

Seems like the following would be reasonable:
1. There should be a "firewall" between the people making the assessment, and the people delivering the treatment. The person who decides what interventions are needed can't have a financial interest in the outcome.
2. Local treatment options should be required, unless the treatment is truly specialized. In rural environments this might be more complicated or impossible.
3. There needs to be an appeal process. If the physician disagrees with the assessment, then there should be an option of getting a second opinion. However, if a physician gets a second opinion, is cleared, and then runs into trouble -- then I think that should end up on their license record.
4. Prhaps some limitations as to what types of problems can be referred in the first place (although this would be hard to operationalize.

I agree with all of these and I'd add there should be some kind of oversight. Right now, PHPs seem to do whatever they want without any national standard nor governing board they have to answer to. This is especially troubling when they have agreements with these stand-alone facilities, some of which aren't even accredited and don't take insurance. Their recommendations should also be backed up by evidence-based medicine (why is 90-day inpatient rehab more beneficial than the standard 30 days? How is a doctor who is experiencing burnout, contributing to conflict at work, better served by an inpatient admission versus therapy? etc).

Also, I'm surprised that any adverse action can be kept off the licensing exam in your state. This is not the case in some states, where the licensing application specifically asks about referrals to PHPs, treatment for substance abuse/mental health, monitoring, etc. All of those questions would have be answered in the affirmative, which opens the door to more questions.

 

[doctorKAT]

PHP programs seem to hurt more than help. I agree physicians who are liscensed and have substance abuse problems ought to be rightly referred. But residents or interns should not be refered for "depression" when there is no clinical evidence that there is depression. This happened to me when all i did was go to my PD asking for extra academic help becuase i thought i was "behind" and wanted to be proactive. Instead she told me i was performing fine and i lack self confidence becuase i was "depressed". Long story short, i ended up resigning to avoid PHP.

 

[NotAProgDirector]

It's possible that some programs see a PHP as a way to "dump" problems. Rather than trying to deal with the issue, they just "refer to PHP and let them deal with it". That's not acceptable.

 

[chocomorsel]

PHP programs seem to hurt more than help. I agree physicians who are liscensed and have substance abuse problems ought to be rightly referred. But residents or interns should not be refered for "depression" when there is no clinical evidence that there is depression. This happened to me when all i did was go to my PD asking for extra academic help becuase i thought i was "behind" and wanted to be proactive. Instead she told me i was performing fine and i lack self confidence becuase i was "depressed". Long story short, i ended up resigning to avoid PHP.

Terrible. Reminds me of my old PD. Evil. Act like they care and want to help, except use whatever information you give them to throw you under the bus.
It’s a power thing. Have you been able to find a new spot?

 

[Sagafemina]

It's possible that some programs see a PHP as a way to "dump" problems. Rather than trying to deal with the issue, they just "refer to PHP and let them deal with it". That's not acceptable.

It's very possible. I've heard from residents to whom it has been done. In both cases, the issue was not mental health or substance abuse but rather whistleblowing on abusive conditions, which was reinterpreted as "disruptive behavior" (for example, posting evidence of abuses online). When the resident is on a J-1 visa, it can terminate a career that is just short of launch.

 

[Sagafemina]

I agree with all of these and I'd add there should be some kind of oversight. Right now, PHPs seem to do whatever they want without any national standard nor governing board they have to answer to. This is especially troubling when they have agreements with these stand-alone facilities, some of which aren't even accredited and don't take insurance. Their recommendations should also be backed up by evidence-based medicine (why is 90-day inpatient rehab more beneficial than the standard 30 days? How is a doctor who is experiencing burnout, contributing to conflict at work, better served by an inpatient admission versus therapy? etc).

Also, I'm surprised that any adverse action can be kept off the licensing exam in your state. This is not the case in some states, where the licensing application specifically asks about referrals to PHPs, treatment for substance abuse/mental health, monitoring, etc. All of those questions would have be answered in the affirmative, which opens the door to more questions.

Their "governing board", the FSPHP, actually promotes all of these reported practices and profits from sponsorship from the "preferred rehab facilities" to which they exclusively refer docs. The reason the facilities don't "take" insurance is that the criteria are not met for inpatient treatment so to even submit claims to insurance would be insurance fraud. So they demand cash up-front, often asking questions such as "isn't your medical license worth $50,000?" There is absolutely NO evidence that physicians require 90 day inpatient rehab when those who are insured and are not docs are "sprung" after 28 days. Members of the drug testing industry have churned a single statistically flawed dataset in one twice published study to create the appearance through other papers reflecting the same data set that somehow this is the "model" of drug treatment that is so successful it should be spread to all other professionals and industries. It's all about deep pockets.

"Participation" in a PHP can be kept off licensure apps in most states. The catch is that you must comply in every particular with the requirements of the PHP...including often this inordinately long inpatient rehab and 5 year monitoring, all at personal expense. Even drinking ginger ale in a champagne glass can be used as evidence of "impairment without use' (true---lookup the FSMB impairment policy) and can spring you for another 5 years of monitoring. It's an incredibly well organized racket. Sadly, it may be harming more than it helps.

 

[Crayola227]

Yeah this isn't the first I've heard about the multi-year (like 3-5 yrs) of intensive monitoring, that is totally a real thing

I make no comment on what triggers that or its merits, just that it isn't an overdramatization

From what I know of what can bring this kind of thing about, it does indeed seem like overkill in some scenarios

 

[Mass Effect]

Their "governing board", the FSPHP, actually promotes all of these reported practices and profits from sponsorship from the "preferred rehab facilities" to which they exclusively refer docs

Do you have evidence of this? I've seen this mentioned and I can speculate it's probably true, but I have yet to see any evidence.

 

[Mass Effect]

Yeah this isn't the first I've heard about the multi-year (like 3-5 yrs) of intensive monitoring, that is totally a real thing

I've heard of it too. I don't know what it entails, but I know it happens.

 

[Sagafemina]

My eyewitness evidence is from representing a major specialty society at FSPHP (and FSMB) meetings over the years. The high level sponsors and exhibitors at these meetings are precisely the same as the "preferred physician rehab facilities" to which PHPs and MLBs exclusively refer. In addition, these exhibitors wine and dine participants at receptions and dinners (at which presentations are made about how wonderful their facilities are). They also sponsor regional meetings of various PHPs at rather posh locations (e.g. Hilton Head). A PHP Director has admitted under oath that there are no specific criteria to justify making these facilities "preferred" for treatment of physicians. And the audit of the NCPHP specifically stated that there was an appearance of COI between such facilities and that PHP, mentioning among other things, "scholarships" paid by the facilities to the PHP http://bit.ly/NCPHPAudit (this particular COI has reportedly now been corrected). So yes, there's evidence. If you, Mass Effect, are from MA, you should critically investigate your own PHP. It has been rejected by, among others, the Harvard system because of some of the more nefarious practices espoused by that PHP.

 

[Mass Effect]

My eyewitness evidence is from representing a major specialty society at FSPHP (and FSMB) meetings over the years. The high level sponsors and exhibitors at these meetings are precisely the same as the "preferred physician rehab facilities" to which PHPs and MLBs exclusively refer. In addition, these exhibitors wine and dine participants at receptions and dinners (at which presentations are made about how wonderful their facilities are). They also sponsor regional meetings of various PHPs at rather posh locations (e.g. Hilton Head). A PHP Director has admitted under oath that there are no specific criteria to justify making these facilities "preferred" for treatment of physicians. And the audit of the NCPHP specifically stated that there was an appearance of COI between such facilities and that PHP, mentioning among other things, "scholarships" paid by the facilities to the PHP http://bit.ly/NCPHPAudit (this particular COI has reportedly now been corrected). So yes, there's evidence. If you, Mass Effect, are from MA, you should critically investigate your own PHP. It has been rejected by, among others, the Harvard system because of some of the more nefarious practices espoused by that PHP.

I'm not from MA, but believe me, you don't have to tell me about the shady things that go on with PHPs, including the one in MA. They put physicians through hell, especially those in training who are most vulnerable to the abuse. I just wish there was hard evidence.

 

[Sagafemina]

If by "hard evidence" you mean a solidly designed and validated survey, it isn't going to happen. Access to participants is closely guarded.
However, there are now several organizations where those with anecdotal experience can get involved and at least register their experiences. Enough of these should help to shed light on the very real problem.

Venues include the Center for Physician Rights www.physicianrights.net and www.phplawsuit.com

 

[Sagafemina]

PHP programs seem to hurt more than help. I agree physicians who are liscensed and have substance abuse problems ought to be rightly referred. But residents or interns should not be refered for "depression" when there is no clinical evidence that there is depression. This happened to me when all i did was go to my PD asking for extra academic help becuase i thought i was "behind" and wanted to be proactive. Instead she told me i was performing fine and i lack self confidence becuase i was "depressed". Long story short, i ended up resigning to avoid PHP.

This is tragic. Both the betrayal by your PD, and the loss to the system of you, a sensitive young physician who no doubt would have made a sentient clinician. I hope you can find your way back into the system at some level, without being discriminated against as you clearly have been, for being human. I hope you have investigated legal options and not just given up.

 

[Mass Effect]

If by "hard evidence" you mean a solidly designed and validated survey, it isn't going to happen. Access to participants is closely guarded.
However, there are now several organizations where those with anecdotal experience can get involved and at least register their experiences. Enough of these should help to shed light on the very real problem.

Venues include the Center for Physician Rights www.physicianrights.net and www.phplawsuit.com

By participants do you mean the centers physicians are sent to? Or do you mean the physicians themselves? What would be helpful is someone who can investigate the money. Where does it go and how is it used.

I do think there are some legitimate reasons to keep PHPs around, but they need to be totally revamped and there should be oversight in eliminate corruption and insure fairness.

 

[OrestesWeed]

If by "hard evidence" you mean evidence of the "diagnosis-rigging" and forensic fraud that is occurring in this system there is actually quite a bit and the specific misconduct the state PHPs are engaging in is becoming quite clear. The primarily problem is there is no one to report it to as the state and federal agencies that are responsible for investigating this manner of misconduct do not take the complaints from medical students or physicians seriously and consider it a parochial issue best handled by medical school administrators or medical licensing boards. Allegations of very serious misconduct that in many cases constitute clear-cut crimes are dismissed at the outset with no investigation and no real inquiry.

There is ample evidence that they are engaging in false diagnoses and over diagnoses at the "PHP-approved" facilities they use. These facilities are giving diagnoses of Substance Use Disorder (SUD) and other mental health diagnoses when the person being evaluated does not meet the diagnostic criteria for the SUD or psychiatric disorder and most of these individuals have 2nd 3rd and even 4th opinions from bona fide experts documenting they do not. The diagnostic rigging involved in providing these false diagnoses involves the use of non-validated neuropsychological testing ( the "360 degree assessment, "modified Rorschach, etc.), polygraphs, and a variety of 12-step oriented "character defect" gibberish. The problem is none of the valid diagnoses (no matter how qualified the evaluator or how extensive the testing) ever gets seen by the full medical board as the state PHPs (in many states such as North Carolina and Massachusetts) have placed PHP affiliated attorneys within the boards and these attorneys act as their own "hearing officers" on cases. Evidence on both sides must be presented directly to these attorneys who pick and choose what is then presented to the board to induce wrong and unjust decisions. The misconduct of these attorneys is uniquely egregious and serious as they are able to manufacture entire cases supporting the PHP's narrative and that is precisely what they do. The primary barrier to exposing this is obtaining the evidence to prove it as its disclosure is intentionally blocked, deflected and refused.

These board attorneys not only omit exculpatory evidence (as has been seen primarily in prosecutorial misconduct cases in the criminal justice system) but they make affirmative representations to boards. Massachusetts State Auditor Suzanne Bump officially began an investigation of the Massachusetts medical board's Physician Health and Compliance (PHC) Unit 4-weeks ago. It is necessary that this be done transparently and the allegations must be taken seriously. The PHPs are also engaging in forensic fraud in collusion with the out-of-pocket for profit labs they contract with using non-FDA approved "laboratory developed tests" that were, in fact, introduced and promoted by state physician health program physicians (and former clients who reintroduced themselves as "addiction medicine" physicians after having their licenses revoked).

These tests are not FDA-approved and have no regulation or oversight. There validity is unknown and the absence of any accountability to outside agencies make them susceptible to abuse. PHPs are not clinical treatment providers and the drug and alcohol testing they perform is forensic and subject to strict chain-of-custody procedures. "Hard-evidence" of the forensic fraud they are engaging in is evinced in the attached documents. A simple fact-check of the time-line and the documents show clear collusion between the PHP, the lab and the MA medical board attorney. http://bit.ly/2Q0E6wg

I have been told by multiple experts in both toxicology and law enforcement that the documents here provide the clearest and most complete example of forensic fraud they have ever seen. The problem is getting the truth and facts seen and acknowledged has been blocked as the PHC Board attorneys concealed all of it for over 6-years. Updated Public Records Law in Massachusetts (effective January 1, 2017) has revealed that all of the documents making the fraud plainly clear are either absent from the board's records or date-stamped long after the proceedings for which they were submitted to be heard. All of this evidence was necessarily submitted directly to these medical board attorneys who by board policy act as their very own hearing officers. They receive all evidence from both sides of the aisle and pick and choose what they present to the board.

As higher courts (administrative, superior, supreme) only look at issues of law (i.e was procedure followed) judicial review is unable to detect intentional fraud which, as seen here, is typically a matter of fact. In this matter the board attorneys omitted all of this evidence from the certified administrative record and bald face lied to the highest court in Massachusetts. A spotlight needs to be put on them to expose board attorney misconduct in the same manner that the Duke Lacrosse case brought prosecutorial misconduct into the public eye. The problem is pervasive and these attorneys appear to be following a script dictated by the PHPs as the patterns of misconduct are specific and clear.

The fraud they are engaging in is specific, serious and egregious and that which is seen here has all been turned over to the state auditor. It is necessary that this audit be conducted transparently and that the allegations be taken seriously. What is seen here is representative of the systemic abuse of administrative process that is occurring across the country. I hear from an average of 4 individuals per week who are victims of this system and they currently have no one to turn to and that needs to change. The forensic fraud just as seen here is being done here over 6-years ago continues to be done blatantly and with no fear of repercussions. A "litigation packet" from a medical student sent to me just 2-months ago showed that the donor ID # of his specimen was changed and the chain-of-custody was fabricated plain as day but there is no one to report it to who will take it seriously. The individuals perpetrating these acts need to be specifically called out and exposed. That will happen eventually but we need to make sure it occurs sooner rather than later. A reckoning needs to occur with dispatch as there are too many innocent lives and livelihoods being destroyed by a small number of sick and sociopathic individuals. The entire system needs to be destroyed and built anew.

 

[Mass Effect]

If by "hard evidence" you mean evidence of the "diagnosis-rigging" and forensic fraud that is occurring in this system there is actually quite a bit and the specific misconduct the state PHPs are engaging in is becoming quite clear. The primarily problem is there is no one to report it to as the state and federal agencies that are responsible for investigating this manner of misconduct do not take the complaints from medical students or physicians seriously and consider it a parochial issue best handled by medical school administrators or medical licensing boards. Allegations of very serious misconduct that in many cases constitute clear-cut crimes are dismissed at the outset with no investigation and no real inquiry.

There is ample evidence that they are engaging in false diagnoses and over diagnoses at the "PHP-approved" facilities they use. These facilities are giving diagnoses of Substance Use Disorder (SUD) and other mental health diagnoses when the person being evaluated does not meet the diagnostic criteria for the SUD or psychiatric disorder and most of these individuals have 2nd 3rd and even 4th opinions from bona fide experts documenting they do not. The diagnostic rigging involved in providing these false diagnoses involves the use of non-validated neuropsychological testing ( the "360 degree assessment, "modified Rorschach, etc.), polygraphs, and a variety of 12-step oriented "character defect" gibberish. The problem is none of the valid diagnoses (no matter how qualified the evaluator or how extensive the testing) ever gets seen by the full medical board as the state PHPs (in many states such as North Carolina and Massachusetts) have placed PHP affiliated attorneys within the boards and these attorneys act as their own "hearing officers" on cases. Evidence on both sides must be presented directly to these attorneys who pick and choose what is then presented to the board to induce wrong and unjust decisions. The misconduct of these attorneys is uniquely egregious and serious as they are able to manufacture entire cases supporting the PHP's narrative and that is precisely what they do. The primary barrier to exposing this is obtaining the evidence to prove it as its disclosure is intentionally blocked, deflected and refused.

These board attorneys not only omit exculpatory evidence (as has been seen primarily in prosecutorial misconduct cases in the criminal justice system) but they make affirmative representations to boards. Massachusetts State Auditor Suzanne Bump officially began an investigation of the Massachusetts medical board's Physician Health and Compliance (PHC) Unit 4-weeks ago. It is necessary that this be done transparently and the allegations must be taken seriously. The PHPs are also engaging in forensic fraud in collusion with the out-of-pocket for profit labs they contract with using non-FDA approved "laboratory developed tests" that were, in fact, introduced and promoted by state physician health program physicians (and former clients who reintroduced themselves as "addiction medicine" physicians after having their licenses revoked).

These tests are not FDA-approved and have no regulation or oversight. There validity is unknown and the absence of any accountability to outside agencies make them susceptible to abuse. PHPs are not clinical treatment providers and the drug and alcohol testing they perform is forensic and subject to strict chain-of-custody procedures. "Hard-evidence" of the forensic fraud they are engaging in is evinced in the attached documents. A simple fact-check of the time-line and the documents show clear collusion between the PHP, the lab and the MA medical board attorney. http://bit.ly/2Q0E6wg

I have been told by multiple experts in both toxicology and law enforcement that the documents here provide the clearest and most complete example of forensic fraud they have ever seen. The problem is getting the truth and facts seen and acknowledged has been blocked as the PHC Board attorneys concealed all of it for over 6-years. Updated Public Records Law in Massachusetts (effective January 1, 2017) has revealed that all of the documents making the fraud plainly clear are either absent from the board's records or date-stamped long after the proceedings for which they were submitted to be heard. All of this evidence was necessarily submitted directly to these medical board attorneys who by board policy act as their very own hearing officers. They receive all evidence from both sides of the aisle and pick and choose what they present to the board.

As higher courts (administrative, superior, supreme) only look at issues of law (i.e was procedure followed) judicial review is unable to detect intentional fraud which, as seen here, is typically a matter of fact. In this matter the board attorneys omitted all of this evidence from the certified administrative record and bald face lied to the highest court in Massachusetts. A spotlight needs to be put on them to expose board attorney misconduct in the same manner that the Duke Lacrosse case brought prosecutorial misconduct into the public eye. The problem is pervasive and these attorneys appear to be following a script dictated by the PHPs as the patterns of misconduct are specific and clear.

The fraud they are engaging in is specific, serious and egregious and that which is seen here has all been turned over to the state auditor. It is necessary that this audit be conducted transparently and that the allegations be taken seriously. What is seen here is representative of the systemic abuse of administrative process that is occurring across the country. I hear from an average of 4 individuals per week who are victims of this system and they currently have no one to turn to and that needs to change. The forensic fraud just as seen here is being done here over 6-years ago continues to be done blatantly and with no fear of repercussions. A "litigation packet" from a medical student sent to me just 2-months ago showed that the donor ID # of his specimen was changed and the chain-of-custody was fabricated plain as day but there is no one to report it to who will take it seriously. The individuals perpetrating these acts need to be specifically called out and exposed. That will happen eventually but we need to make sure it occurs sooner rather than later. A reckoning needs to occur with dispatch as there are too many innocent lives and livelihoods being destroyed by a small number of sick and sociopathic individuals. The entire system needs to be destroyed and built anew.

First, thank you for posting all of this. It's very informative. Are you sure the audit just started? On the Mass.gov site, it lists an audit back in August 2018 of PHP. I'm confused as to whether this is a standard audit or if they're finally listening to people. Same goes for Michigan where a class action lawsuit is underway.

 

[Mass Effect]

I wanted to get the community opinion on this news story in my city. Apparently, local hospitals are using the Physicians Health Program to push out doctors with disabilities or who may make a patient safety claim. Physicians with no addiction issues were being forced into 60-90 days of in-patient rehab programs to keep their license. I know these programs are intended to help healthcare workers with addiction issues but this report is concerning. New Story on residents sent to PHPs below:
Doctors fear controversial program made to help them

Is this going on at your hospital and a common thing nationwide?

There's a follow up.

Doctor left destitute after seeking help from physician health program

A program designed to help depressed and addicted doctors has been blamed for ruining lives, and even driving some physicians to suicide.

www.ksdk.com

 

[IMreshopeful]

There's a follow up.

Doctor left destitute after seeking help from physician health program

A program designed to help depressed and addicted doctors has been blamed for ruining lives, and even driving some physicians to suicide.

www.ksdk.com

My god. That’s a horrifying story.

The level of corruption, evil, and greed in these organizations is unbelievable. No doubt that state senator is getting kickbacks as well from the person running the PHP... even despite being a doctor. Guess there’s some evil docs who will throw their colleagues under the bus just for some cash

 

[Mad Jack]

Being forced into a PHP for depression seems ridiculous, particularly for residents, as residency is often a fairly depressing endeavor and mild depression is probably quite common. That makes enforcement an arbitrary measure targeted at likely "problem" residents, to be used as punishment rather than a means of protecting the public. You can have mild to moderate depression and function fairly well, even exceptionally, at work. PHPs should be reserved for those that present an actual risk to themselves or others rather than anyone who has ever had a mental health issue or dared have a drink of alcohol.

Truly though, I am concerned by the lack of checks and balances, as it seems no one is watching the watchmen

 

[NotAProgDirector]

I am a huge proponent of PHP oversight, and these distant referrals to "expert centers" are crazy.

But the linked article is poor reporting and seems very biased.

I get the sense from the article and what happened that this physician was prescribing benzo's to himself. That's a huge problem.

Article mentions that withdrawing from benzo's is dangerous, also that he was on "low dose". Benzo withdrawal is uncomfortable, but not really dangerous (other than risk of suicide). And if he was on low dose, really shouldn't have been an issue at all.

Mentioned that he was a doc for 30 years, and then spent his life savings of $50,000. This suggests deeper problems here.

Also, article seems to mention that they were going to let him come back to work, but that he would have to pay for monitoring which was $1200 per month, and he couldn't afford that. Should be affordable for most physicians, I would think. Esp if your whole career is on the line.

 

[Mass Effect]

I am a huge proponent of PHP oversight, and these distant referrals to "expert centers" are crazy.

But the linked article is poor reporting and seems very biased.

I get the sense from the article and what happened that this physician was prescribing benzo's to himself. That's a huge problem

Agreed with this and wish they had explored what this was about.

Article mentions that withdrawing from benzo's is dangerous, also that he was on "low dose". Benzo withdrawal is uncomfortable, but not really dangerous (other than risk of suicide). And if he was on low dose, really shouldn't have been an issue at all

No matter how rare, a risk for benzo withdrawal is still seizure, not just discomfort.

Mentioned that he was a doc for 30 years, and then spent his life savings of $50,000. This suggests deeper problems here

Agreed, and that surprised me too, but doesn't necessarily mean something nefarious. That could also be referring to money that's not invested for retirement.

Also, article seems to mention that they were going to let him come back to work, but that he would have to pay for monitoring which was $1200 per month, and he couldn't afford that. Should be affordable for most physicians, I would think. Esp if your whole career is on the line.

While I agree that $1200 may be affordable for a practicing physician, Who are they to ask for it? What does monitoring even entail that it costs the same as a month's rent in many places? And why does PHP get to make the decision as to what's included and how long it goes on? Unless it's evidence-based treatment, I'm going to call it extortion.

I think there are docs out there who are impaired and need help. That makes my resentment toward PHPs much greater because they could have been in a position to legitimately help and instead, this what they choose to do with that potential.

 

[NotAProgDirector]

I agree that seizures are a risk, and in fact are mentioned in the article. But the article also says he was on "low dose", which is inconsistent with withdrawal. But I agree I was a bit cavalier about that, unfair to the person in this situation.

Again, I agree that PHP power can be abused and a system of checks-and-balances may be needed.

Sounds like this guy was addicted to benzos, and it was affecting his work (hence why his hospital told him he needed to get help). I expect his license was suspended until he was evaluated by the PHP and deemed healthy to return to work. This is completely reasonable -- he shouldn't be able to work until we are certain he is sober and stable. I think we agree there.

But this does lead to some interesting questions:

1. How do we know when someone is safe? Let's say this guy goes to a 6 week recovery program, and let's assume that his depression is treated appropriately also. Does he get to just start working? How long does he need to maintain a benzo-free life before his license is returned? I don't have an evidence based answer, but giving him his license back just out of rehab seems wrong, and 6 months seems too long. I'd pick 1-3 months, but I don't have any evidence for that.

2. Who should pay for the testing and treatment?
Health Insurance is one option, although I can understand if insurance decides it's not their responsibility to pay for weekly drug tests (usually should cover psych and addiction visits, unless the Board/PHP mandates more visits than would be usually scheduled)
The Board -- another option, but if we choose this one then everyone's fees go up to cover it. The money has to come from somewhere.
The person -- If you don't like either of the above options, this is what's left.

3. The cost -- I agree that $1200 seems excessive, and if he has to pay that while unemployed is a bigger problem. If he had disability insurance, should help with costs -- if he did not, that's his mistake. The article seemed to suggest that he'd need to do that for 5 years before he would get his license back, which is almost certainly incorrect.

Specialized out of state treatment should be avoided. It may be required for very specialized situations -- boundary violations, or ethics problems, etc. But routine substance abuse should be treatable locally, treating physicians is no different than anyone else. Routine monitoring with blood/urine will require a lab that can handle it for legal matters.

So, my question to you is: What do you think would be a reasonable plan, assuming the story above is accurate?

 

[Perrotfish]

I agree that seizures are a risk, and in fact are mentioned in the article. But the article also says he was on "low dose", which is inconsistent with withdrawal. But I agree I was a bit cavalier about that, unfair to the person in this situation.

Again, I agree that PHP power can be abused and a system of checks-and-balances may be needed.

Sounds like this guy was addicted to benzos, and it was affecting his work (hence why his hospital told him he needed to get help). I expect his license was suspended until he was evaluated by the PHP and deemed healthy to return to work. This is completely reasonable -- he shouldn't be able to work until we are certain he is sober and stable. I think we agree there.

But this does lead to some interesting questions:

1. How do we know when someone is safe? Let's say this guy goes to a 6 week recovery program, and let's assume that his depression is treated appropriately also. Does he get to just start working? How long does he need to maintain a benzo-free life before his license is returned? I don't have an evidence based answer, but giving him his license back just out of rehab seems wrong, and 6 months seems too long. I'd pick 1-3 months, but I don't have any evidence for that.

2. Who should pay for the testing and treatment?
Health Insurance is one option, although I can understand if insurance decides it's not their responsibility to pay for weekly drug tests (usually should cover psych and addiction visits, unless the Board/PHP mandates more visits than would be usually scheduled)
The Board -- another option, but if we choose this one then everyone's fees go up to cover it. The money has to come from somewhere.
The person -- If you don't like either of the above options, this is what's left.

3. The cost -- I agree that $1200 seems excessive, and if he has to pay that while unemployed is a bigger problem. If he had disability insurance, should help with costs -- if he did not, that's his mistake. The article seemed to suggest that he'd need to do that for 5 years before he would get his license back, which is almost certainly incorrect.

Specialized out of state treatment should be avoided. It may be required for very specialized situations -- boundary violations, or ethics problems, etc. But routine substance abuse should be treatable locally, treating physicians is no different than anyone else. Routine monitoring with blood/urine will require a lab that can handle it for legal matters.

So, my question to you is: What do you think would be a reasonable plan, assuming the story above is accurate?

1) The accused has a right to a lawyer and a hearing. The evaluating psychiatrist should be giving recommendations for a plan of care, not orders. The physician should have the right to go in front of a judge, with a lawyer, and make his case against the psychiatrists recommendations, and then a jury if he disagrees with the judge, just like we currently do with competency hearings
2) Referrals for a civilian physician should need to be signed off on by some kind of committee not associated with the individual's department, particularly or trainees. You wouldn't have an IRB made up of just the researchers involved in the project, and you shouldn't have a referral that goes just through the program director
3) This should go without saying, but the evaluating psychiatrists shouldn't have any financial connections to any treating facility. Ideally the state department of health should employ the evaluating psychiatrists/addiction medicine specialists.
4) A baseless referral, and particularly a pattern of baseless referrals, should be actionable. Programs that use referrals to discipline problem residents need to be placed on probation, healthcare systems that do so need to be fined significant amounts of money.
5) Drug monitoring programs should be run through a physician's place of employment. Physicians on such programs should, by extension, be limited to positions where they are employed and supervised and the monitoring should be without cost. The actual cost of drug monitoring is quite low.
6) Treatment beyond drug monitoring should be covered by Medicaid/Medicare, just as resident training is. The goal is the same: get physicians into practice. Also since the treatment is not making anyone any money I think the state would be more likely to limit treatment to evidence based interventions.

 

[Crayola227]

I'll throw in as well that death is always one risk of seizures, no matter how rare.

 

[Crayola227]

Healthcare bills, labs, rehab whether it's inpt or outpt, and I suspect that these "centers" charge those prices, can quite easily amount to close to $50K.

 

[Crayola227]

Uh, did we miss the part of the article that says that he was not only on low-dose, but never took more than what he was prescribed?

And he reports that he did indeed experience seizures from withdrawal. It doesn't come out and say that his taper was handled badly, but we already have one physician in this forum asserting that cessation of low-dose benzo should be NBD (and there is nuance on the topic), and the article does suggest that he was stopped cold turkey, so I wonder if his treating providers thought so as well and didn't taper properly. Some addiction treatment centers can have more or less physician or other healthcare provider oversight as well.

Lol, then he said he would die (not wrong if he's seizing) and that was the point they drove him somewhere else.

Also, the implication was not that he had to complete 5 years of monitoring BEFORE getting his license back, just that he had to sign up and agree to that. And I know for a fact that 5 year monitoring requirements to maintain licensure is a thing. The idea being that after 5 years you can finally go back to the typical oversight all physicians are under. But if at any point you run afoul or can't afford the monitoring, you absolutely could be facing career ruin.

I'm sort of chewing on the idea that this guy was addicted to benzos. Not to mention that he could be dependent, yet not abusing. As in, he was placed on benzo therapy by someone down the line, and now he's got an issue getting off, so he's basically just being maintained. I also kind of wonder if that's here nor there in what happened.

To my mind, that is a health condition. Physicians have all kinds of health conditions, like tobacco use disorders or headaches or etc. These conditions can even affect your job performance, although maybe not to a level that is dangerous.

So at what point do we invoke the PHP for your migraines or seizures?

The next point someone will make has to do with "sobriety." I don't think just because someone is on a centrally acting medication where they have tolerance, that they are by definition intoxicated and impaired. What if he had been taking low-dose benzos for his seizures? Could he be safe to practice? Why does taking it for anxiety differ?

Seroquel is sedating. So are all bipolar physicians taking it, impaired? What about if they then take a benzo for akathisia secondary to their treatment? Are all sleep-deprived residents who also feel drowsy also impaired?

It's not clear to me that he actually did anything wrong regarding his medical condition and use of prescribed medications, or that it affected his work. Reading the article, it sounds like he was upfront about his condition and medication use, and may have been dealing with mood symptoms. There's a lot of ways that he could have been funneled into the PHP that may not have had anything to do with any actual misconduct on his part. Not sure why we assume otherwise based on the article. Not saying that it's extremely well-written, but just going off the story, I'm a bit disturbed by some of the assumptions being made. (On the topic of mood symptoms, I know plenty of physicians with anxiety. Some with panic attacks. Some who do have it interfere with their work to some degree but isn't dangerous).

Lastly, where this physician ended up after losing his license to practice, and the bills that he would have incurred from all of this, is completely within the realm of possibility, and without him having been a spendthrift.

 

[Mad Jack]

I am a huge proponent of PHP oversight, and these distant referrals to "expert centers" are crazy.

But the linked article is poor reporting and seems very biased.

I get the sense from the article and what happened that this physician was prescribing benzo's to himself. That's a huge problem.

Article mentions that withdrawing from benzo's is dangerous, also that he was on "low dose". Benzo withdrawal is uncomfortable, but not really dangerous (other than risk of suicide). And if he was on low dose, really shouldn't have been an issue at all.

Mentioned that he was a doc for 30 years, and then spent his life savings of $50,000. This suggests deeper problems here.

Also, article seems to mention that they were going to let him come back to work, but that he would have to pay for monitoring which was $1200 per month, and he couldn't afford that. Should be affordable for most physicians, I would think. Esp if your whole career is on the line.

Regardless of dose, you can hit full status epilepticus from benzo withdrawal and die, not to mention the risk of aspiration and airway compromise from a good old fashioned seizure. He was older at the time, so even low-dose benzos can result in some pretty nasty withdrawal on a more frequent basis

 

[Mad Jack]

I agree that seizures are a risk, and in fact are mentioned in the article. But the article also says he was on "low dose", which is inconsistent with withdrawal. But I agree I was a bit cavalier about that, unfair to the person in this situation.

Again, I agree that PHP power can be abused and a system of checks-and-balances may be needed.

Sounds like this guy was addicted to benzos, and it was affecting his work (hence why his hospital told him he needed to get help). I expect his license was suspended until he was evaluated by the PHP and deemed healthy to return to work. This is completely reasonable -- he shouldn't be able to work until we are certain he is sober and stable. I think we agree there.

But this does lead to some interesting questions:

1. How do we know when someone is safe? Let's say this guy goes to a 6 week recovery program, and let's assume that his depression is treated appropriately also. Does he get to just start working? How long does he need to maintain a benzo-free life before his license is returned? I don't have an evidence based answer, but giving him his license back just out of rehab seems wrong, and 6 months seems too long. I'd pick 1-3 months, but I don't have any evidence for that.

2. Who should pay for the testing and treatment?
Health Insurance is one option, although I can understand if insurance decides it's not their responsibility to pay for weekly drug tests (usually should cover psych and addiction visits, unless the Board/PHP mandates more visits than would be usually scheduled)
The Board -- another option, but if we choose this one then everyone's fees go up to cover it. The money has to come from somewhere.
The person -- If you don't like either of the above options, this is what's left.

3. The cost -- I agree that $1200 seems excessive, and if he has to pay that while unemployed is a bigger problem. If he had disability insurance, should help with costs -- if he did not, that's his mistake. The article seemed to suggest that he'd need to do that for 5 years before he would get his license back, which is almost certainly incorrect.

Specialized out of state treatment should be avoided. It may be required for very specialized situations -- boundary violations, or ethics problems, etc. But routine substance abuse should be treatable locally, treating physicians is no different than anyone else. Routine monitoring with blood/urine will require a lab that can handle it for legal matters.

So, my question to you is: What do you think would be a reasonable plan, assuming the story above is accurate?

Oh, and with regard to five years- basically every PHP runs mandatory five year contracts that are cookie cutter in nature, treating everyone as a drug addict regardless of pathology. This guy should have had the same treatment as literally everyone else with anxiety- a slow benzo taper with initiation of antidepressants and therapy, which should have been covered by insurance.

 

[NotAProgDirector]

I have already stated above (and agree) that benzo withdrawal can be dangerous, and can lead to harm.

There are two interrelated discussions here -- what should we do (in general) about impaired physicians, and what happened to this guy.

In general:

1) The accused has a right to a lawyer and a hearing. The evaluating psychiatrist should be giving recommendations for a plan of care, not orders. The physician should have the right to go in front of a judge, with a lawyer, and make his case against the psychiatrists recommendations, and then a jury if he disagrees with the judge, just like we currently do with competency hearings

I'm not convinced this is a good plan. Courts are not well suited to determine whether professionals are competent to practice their trade. Courts have long deferred these decisions to the trade itself. In fact, I'd be worried that a jury would not give physicians with drug problems or other issues a second chance. And, legal processes take forever to complete -- whom would decide whether the physician could practice in the interim, and how they would be followed? The current system clearly has problems, but I don't think this is a solution. If people file false claims to get competitors removed -- that's a crime, that belongs in court.

2) Referrals for a civilian physician should need to be signed off on by some kind of committee not associated with the individual's department, particularly or trainees. You wouldn't have an IRB made up of just the researchers involved in the project, and you shouldn't have a referral that goes just through the program director

Totally agree. Presumably this is what the board of medicine and PHP are for. Anyone affiliated with the physician involved should be recused.

3) This should go without saying, but the evaluating psychiatrists shouldn't have any financial connections to any treating facility. Ideally the state department of health should employ the evaluating psychiatrists/addiction medicine specialists.

Totally 150% agree

4) A baseless referral, and particularly a pattern of baseless referrals, should be actionable. Programs that use referrals to discipline problem residents need to be placed on probation, healthcare systems that do so need to be fined significant amounts of money.

Also agree, although defining "baseless" can be complicated.

5) Drug monitoring programs should be run through a physician's place of employment. Physicians on such programs should, by extension, be limited to positions where they are employed and supervised and the monitoring should be without cost. The actual cost of drug monitoring is quite low.

I'm going to disagree here. First, lots of physicians are not hired by hospitals. If someone is in private practice, they can't just get some hospital to hire them. Second, the hospital might be biased one way or another. Third, the testing needs to be done in such a way that it's legally admissible, since it might end up in court and most hospitals can't do this.

I do think that the testing should be done in a way that is as minimally disruptive to the physician as possible. The goal should be to get the physician back to work as quickly and safely as possible. I don't know how long that takes, and I expect that it will be different for various people. Some mechanism of assessment is needed. I would love to see some standard -- physician goes to rehab or some treatment program, continues with ongoing care, and has negative tests for some period of time. There probably should be a minimum treatment time. Allowing private docs / psychiatrists to assess when someone is ready to come back can be problematic, but mandating "specialists" is likewise problematic, and I'd probably choose the local / less disruptive option. I would be OK with ongoing testing being paid by the board, knowing that my fees would go up.

6) Treatment beyond drug monitoring should be covered by Medicaid/Medicare, just as resident training is. The goal is the same: get physicians into practice. Also since the treatment is not making anyone any money I think the state would be more likely to limit treatment to evidence based interventions.

I think I already said this above, but I agree that regular medical insurance should pay for this, although I don't think it has anything to do with resident training payments. Physicians should get the same coverage that non-physicians would get for drug problems.

My thoughts:
1. I think that well run PHP's can be very effective. They need to focus on physician treatment (not punishment), get people back to work as quickly and safely as possible.
2. Treatment should be local whenever possible. Only in extenuating circumstances where it's impossible to treat locally should distance programs be considered. We have fallen prey to the siren of "credentialed / standardized" services, without evidence that they are any better.
3. The only parts of a PHP plan that should be mandated are regular drug testing and medical/psych follow up. Self help groups, forced medications, behavioral therapy, etc all should be up to the patient and their team.
4. Most of this should fall under medical insurance. Drug testing should be covered by the medical board.
5. Some sort of PHP oversight is needed

Regarding this case, I expect the situation is more complicated than the news article suggests. If someone comes on SDN and posts that they are being fired by their residency program for no reason, the usual response is doubt, and as more of the story unfolds it usually becomes more clear why the program is taking that action. I highly doubt that the whole story here was that he was on legally prescribed benzos for depression / anxiety (which is a very poor option) and referred to the PHP for no reason. But it's sad that his career is over, I'd like to think that he could recover. We only have one side of the story -- it's possible the people caring for him did all they could yet this was the result anyway.

 

[Perrotfish]

I'm not convinced this is a good plan. Courts are not well suited to determine whether professionals are competent to practice their trade. Courts have long deferred these decisions to the trade itself. In fact, I'd be worried that a jury would not give physicians with drug problems or other issues a second chance. And, legal processes take forever to complete -- whom would decide whether the physician could practice in the interim, and how they would be followed? The current system clearly has problems, but I don't think this is a solution. If people file false claims to get competitors removed -- that's a crime, that belongs in court.

So the legal process isn't meant to be the first stop, but rather a check on the initial evaluation, similar to how we would allow someone to appeal their own competence to make medical and legal decisions for themselves. If it were up to me the process would that, when a physician gets referred:
1) They see a state board employed psychiatrist and receive a recommended plan of care. If the physician agrees with the plan of care, or if the psychiatrist finds the referral to be baseless, then that's where the process ends.
2) If the physician disagrees with the plan of care and can't reach a resolution with the evaluating psychiatrist they go in front of a judge. License to practice can be suspended for no more than 2 weeks pending that hearing (after that they are reinstated pending the judge's evaluation, to ensure prompt due process). Judge hears testimony from the state psychiatrist as well as any second or third opinions the referred physician can produce. If the judge finds the referral baseless, or alters the plan of treatment to the physician's satisfaction, then the process ends
3) A jury only gets involved if both the treating psychiatrist and the reviewing judge believe the physician is not competent to practice and can't reach a resolution with the physician for an appropriate plan of care. It doesn't have to be a random jury of the physician's peers, it could be a panel of physicians selected by the board if that seems like a better solution. They are the final point of appeal. The referred physicians license can be suspended for no more than 6 months pending the ruling by the jury. If they rule against the physician there isn't anyone else to appeal to and the referred has to complete the evaluating psychiatrists full plan of care to be licensed to practice.

An appeal should never be able to make the situation worse for the referred physician. The absolute worst case scenario would always be the plan of care recommended by the initial evaluating psychiatrist.

 

[chestmedicine]

I have been looking at the details of FSPHP's flagship operation, the Colorado Physician Health Program,for the last three years. I have accumulated troves of material about the actual operation of this program under state open record statutes. This year, the contract of CPHP with the State of Colorado is set to expire June 24, 2019 and attempts to secure a new contract have not been successful through the competitive bidding process. The current contract was arranged as a sole source procurement. The Colorado Department of Regulatory Agencies that houses the Colorado Medical Board convened a public stakeholder meeting on May 16, 2019 to gather commentary about how the new bid solicitation should be structured. Also, the Colorado Medical Practice Act came up for sunset review and the operation of CPHP was the subject of testimony in the Colorado General Assembly. I have included Google Drive links to documents that describe these ongoing public controversies in the hope that readers on this forum will find them useful.

Transcript of the RFP Stakeholder Public Meeting:

Written Public Commentary on the CPHP RFP: AND

 

[NotAProgDirector]

So the legal process isn't meant to be the first stop, but rather a check on the initial evaluation, similar to how we would allow someone to appeal their own competence to make medical and legal decisions for themselves. If it were up to me the process would that, when a physician gets referred:
1) They see a state board employed psychiatrist and receive a recommended plan of care. If the physician agrees with the plan of care, or if the psychiatrist finds the referral to be baseless, then that's where the process ends.
2) If the physician disagrees with the plan of care and can't reach a resolution with the evaluating psychiatrist they go in front of a judge. License to practice can be suspended for no more than 2 weeks pending that hearing (after that they are reinstated pending the judge's evaluation, to ensure prompt due process). Judge hears testimony from the state psychiatrist as well as any second or third opinions the referred physician can produce. If the judge finds the referral baseless, or alters the plan of treatment to the physician's satisfaction, then the process ends
3) A jury only gets involved if both the treating psychiatrist and the reviewing judge believe the physician is not competent to practice and can't reach a resolution with the physician for an appropriate plan of care. It doesn't have to be a random jury of the physician's peers, it could be a panel of physicians selected by the board if that seems like a better solution. They are the final point of appeal. The referred physicians license can be suspended for no more than 6 months pending the ruling by the jury. If they rule against the physician there isn't anyone else to appeal to and the referred has to complete the evaluating psychiatrists full plan of care to be licensed to practice.

An appeal should never be able to make the situation worse for the referred physician. The absolute worst case scenario would always be the plan of care recommended by the initial evaluating psychiatrist.

Stating that a judge review must occur within 2 weeks is, I think, unreasonable. Lots of legal processes feel that they should be fast tracked -- and fast tracking any one process slows down all other processes. I have patients in the hospital waiting to go to a nursing home for MONTHS because the courts can't get around to assigning a guardian. One patient was in the hospital for more than a year waiting.

I worry that a judge won't be in a good position to make this type of decision. Psych1 says: "It's totally unsafe for this physician to practice. They need X, Y and Z". Psych2 says: "It's totally fine, this is nothing". Judges aren't medical experts. I worry they will always go with the more conservative choice -- they don't want to be the person who allows a physician to practice and then something bad happens.

I agree a random jury is a bad idea. A panel of experts to help determine whether someone is able to practice or not -- that sounds much like the Board of Medicine to me. Creating a new system where physicians are called for "appeal duty" like jury duty sounds like a huge pain (biased perhaps by the fact that I was just called for jury duty)

Although I agree an appeal shouldn't make things worse by itself, 3 months later (when the appeal is happening) it's possible that the facts could be worse. A physician suspended for alcohol use who then appeals, and then has a DWI, might end up with a worse outcome I would think -- or perhaps the appeal would be denied and then the board would address the new issue.

All that said, I don't have a better idea, except that I think that all substance issues should be addressed via a protocol which treats the physician locally, gets them back to work ASAP, with the only mandate for ongoing testing (probably funded by the board) and medical or psych regular treatment (notes not shared with the board). Once a reasonable but short period of sobriety is documented, the physician can return to work. Recurrences might trigger longer periods of sobriety before returning to work. Self help groups, medications, CBT, etc would all be optional. All treatment would be paid with medical insurance.

One interesting appeal option would be to have a different state board review appeals. Or, regionally boards could create appeal review boards (i.e. New England, Mid Atlantic, etc). But I worry this would create a similar situation to our legal system -- everyone who loses appeals.

 

[Apollyon]

But I worry this would create a similar situation to our legal system -- everyone who loses appeals.

Or, it could be like med school in Nigeria - outside examiners from other schools come in, and grade you, and that's your lot. If that examiner fails you, no appeal, no recourse, no dice, man!

 

[OrestesWeed]

First, thank you for posting all of this. It's very informative. Are you sure the audit just started? On the Mass.gov site, it lists an audit back in August 2018 of PHP. I'm confused as to whether this is a standard audit or if they're finally listening to people. Same goes for Michigan where a class action lawsuit is underway.

The MA state auditor Suzanne Bump’s office officially started the state audit 2-months ago of the MA medical board’s physician health and compliance attorneys. Not sure what audit you are referring to?

 

[Mass Effect]

1. How do we know when someone is safe? Let's say this guy goes to a 6 week recovery program, and let's assume that his depression is treated appropriately also. Does he get to just start working? How long does he need to maintain a benzo-free life before his license is returned?

What would your answer be if it was alcohol? Also, was he impaired because of depression or because of a benzo addiction? Those two things aren't the same and benzos aren't used to treat depression. So if it was his depression that caused concern and he was on benzos for a co-morbid anxiety disorder and using them properly, then benzos shouldn't have even been a part of the discussion.

I don't have an evidence based answer, but giving him his license back just out of rehab seems wrong, and 6 months seems too long. I'd pick 1-3 months, but I don't have any evidence for that

Why does it seem wrong? It's an illness and he received inpatient help. Also PHPs require 90-day rehabs in a lot of cases (which is total BS). They create a different standard for doctors than for the general public and you're proposing expanding that standard, not just to treatment but recovery.

2. Who should pay for the testing and treatment?
Health Insurance is one option

Ah, but not with PHPs. The facilities they work with don't take insurance. That's why it's a scheme and why it should be toppled and the financial records of every person involved investigated. If it turns out they were receiving kickbacks and applying subjective non-evidence-based standards to physicians, I'd argue that's criminal.

6) Treatment beyond drug monitoring should be covered by Medicaid/Medicare, just as resident training is. The goal is the same: get physicians into practice. Also since the treatment is not making anyone any money I think the state would be more likely to limit treatment to evidence based interventions

Totally agree with this. Residents should not be made to pay insane amounts of money under threat of loss of licensure.

So at what point do we invoke the PHP for your migraines or seizures?

It would be fantastic if PHPs were totally revamped WITH OVERSIGHT and a physician could legitimately turn to them for referrals rather than forfeiting their autonomy. I wish they could be there for these types of referrals and not just for mental health issues either. The idea behind them is great. The problem is corruption.

The next point someone will make has to do with "sobriety." I don't think just because someone is on a centrally acting medication where they have tolerance, that they are by definition intoxicated and impaired. What if he had been taking low-dose benzos for his seizures? Could he be safe to practice? Why does taking it for anxiety differ?

Agree with this. While benzos aren't the best medications, there are people on them chronically and if there is no impairment, this shouldn't be an issue.

I worry that a judge won't be in a good position to make this type of decision. Psych1 says: "It's totally unsafe for this physician to practice. They need X, Y and Z". Psych2 says: "It's totally fine, this is nothing". Judges aren't medical experts. I worry they will always go with the more conservative choice -- they don't want to be the person who allows a physician to practice and then something bad happens

But this happens everyday in court. One medical expert says one thing. Another medical expert says another. Judges are tasked with making the best decision they can based on the law. Is the physician impaired? If so, how? Are there poor patient outcomes that could have been avoided if the physician weren't "impaired"? We're not asking judges to go above and beyond their daily duties; we're just trying to take the politics and corruption out of physician treatment.

The MA state auditor Suzanne Bump’s office officially started the state audit 2-months ago of the MA medical board’s physician health and compliance attorneys. Not sure what audit you are referring to?

Just whatever was on the MA website. Not sure. I am glad to hear there's an audit going on, regardless, and I'm eagerly awaiting the results. I'm curious what happens to all the docs currently caught up with the MA PHP. If there is corruption found, I assume all the docs caught up in a current PHP contract will have case reviews. Also, I just read Suzanne Bump disclosed her connection to addiction and drug-testing facilities in MA (found with a Google search).

Another thing I want to mention is that PHPs should be used for legit medical reasons. Residents being referred for being behind on notes or being disruptive or nonsense like that sounds very much like discipline.

 

[Perrotfish]

I worry that a judge won't be in a good position to make this type of decision. Psych1 says: "It's totally unsafe for this physician to practice. They need X, Y and Z". Psych2 says: "It's totally fine, this is nothing". Judges aren't medical experts. I worry they will always go with the more conservative choice -- they don't want to be the person who allows a physician to practice and then something bad happens.

We involve a judge every time we place a psych hold on someone for more than 72 hours. How is this different?

 

[NotAProgDirector]

Why does it seem wrong? It's an illness and he received inpatient help. Also PHPs require 90-day rehabs in a lot of cases (which is total BS). They create a different standard for doctors than for the general public and you're proposing expanding that standard, not just to treatment but recovery.

I've had lots of patients that are discharged from (inpatient) rehab and relapse very quickly. Hence, my thought is that the physician would need to demonstrate some period of maintenance of sobriety after rehab.

We involve a judge every time we place a psych hold on someone for more than 72 hours. How is this different?

Maybe it isn't? My experience with the judicial system has been slow and horrible. Perhaps it can be better.

 

[Mass Effect]

I've had lots of patients that are discharged from (inpatient) rehab and relapse very quickly. Hence, my thought is that the physician would need to demonstrate some period of maintenance of sobriety after rehab.

And there are a lot of patients who relapse years down the road. Unless there is actual impairment or the doc is showing up to work intoxicated, I disagree that a period of sobriety (beyond rehab) needs to be maintained before giving someone back their license.

 

[NotAProgDirector]

And there are a lot of patients who relapse years down the road. Unless there is actual impairment or the doc is showing up to work intoxicated, I disagree that a period of sobriety (beyond rehab) needs to be maintained before giving someone back their license.

I could support this plan as long as there is monitoring. If they show up for work intoxicated, does that change anything? Once they are sober, the issue is resolved. And how do we define "intoxicated"? Same as DWI?